Abstract: Objective To explore the accuracy of posterior pedicle screws placement for surgical correction of spinal deformity with different extent of vertebral rotation. Methods Sixty-three patients who underwent surgical spinal deformity correction in our department from June 2009 to September 2012 were included and their clinical data were retrospectively analyzed. Of all 63 patients，there were 28 males and 35 females with an average age of 18.87±12.04 years ranging from 3 to 63 years. After the completion of all pedicle screws insertion and before correction， intraoperative CT scan was applied and three dimensional image was reconstructed to measure vertebral rotation degree （R） and access the accuracy of each screw. According to the vertebral rotation degree， all screws were divided into 4 groups （Group 1: R=0°； Group 2: 0°- 10°； Group 3: 11°- 20°； Group 4: R＞ 20°）. Grade Ⅱ and Ⅲ screws were defined as malposition and needed revision. Broken screws rate， malposition rate of each group with different magnitude of vertebral rotation were calculated and analyzed. Results There were 1 072 pedicle screws placed in 63 patients including 206 screws in Group 1， 534 screws in Group 2， 252 screws in Group 3 and 80 screws in Group 4 after intraoperative CT measurement. The broken screws rate in Group 1 was 4.4% （9 screws） and 5.8% （31 screws）， 20.6% （52 screws）， 40% （32 screws） in Group 2， 3， 4 respectively. And the malposition rate of each group was 1.9% （4 screws） in Group 1 ， 2.6% （14 screws） in Group 2， 9.9% （25 screws） in Group 3 and 27.5% （22 screws） in Group 4. Compared with Group 1 and Group 2， significant higher broken screws rate and malposition rate were found in Group 3 and Group 4 （P＜ 0.01）. However， it revealed a significant higher broken screws rate and malposition rate in Group 4 in comparison to Group 3 （P＜ 0.05）. Conclusion Vertebral rotation provides an obvious influence in accuracy of posterior pedicle screws placement for surgical spinal deformity correction. Screws placement accuracy will be lower when vertebral rotation is severer.